The deadly link between bipolar disorder and alcohol
Mental health can range from mild situations such as stress to bipolar disorders, which are more severe.
What you need to know:
- Bipolar disorder is a mental health condition characterised by extreme mood shifts, including emotional highs (mania or hypomania) and lows (depression).
Every March 30, the world observes World Bipolar Disorder Day to raise global awareness, eliminate social stigma, and foster understanding of the condition. The date was intentionally chosen to honour Vincent van Gogh, a Dutch artist who was posthumously diagnosed as having likely lived with bipolar disorder.
Van Gogh’s story is often cited as a representation of the complex relationship between creativity and mental illness. He is believed to have suffered from severe mood fluctuations, including depression and mania. Research shows that his brilliance was frequently hijacked by a biological storm,including hallucinations, that he desperately and unsuccessfully tried to calm with alcohol.
His life followed a classic bipolar trajectory, with deep periods of depression following career failures or romantic rejection, followed by violent rages, and thereafter, intense, hyper-religious remorse. The turning point in his health occurred in Paris, where he began consuming absinthe, a highly bitter alcoholic beverage traditionally produced by macerating wormwood and other botanicals in alcohol.
The journal ScienceDirect notes that absinthe is known for its historical association with addiction and psychoactivity, primarily due to the presence of thujone, a compound with known convulsive properties. Van Gogh would eventually take his life in 1890, shortly after his brother’s death.
Years after his death, scholars suggested that he had bipolar disorder and borderline personality disorder. An analysis of his life shows it was marked by cycles of intense artistic activity (potential mania) followed by severe depressive episodes with psychotic symptoms. Scholars also suggest that alcohol addiction, malnutrition, and rising social tensions exacerbated these conditions, leading Van Gogh to cut off his own ear.
To understand this condition better and its linkage to alcoholism, Nation reached out to Arthur Gichuru, a psychologist at Serenityminds Wellness in Westlands, Nairobi.
What is bipolar disorder?
Bipolar disorder is a mental health condition characterised by extreme mood shifts, including emotional highs (mania or hypomania) and lows (depression).
Does alcohol consumption cause bipolar disorder?
Alcohol and drugs do not cause bipolar disorder on their own, but they can trigger episodes in individuals who are genetically predisposed. They can also worsen the severity and frequency of mood episodes and interfere with treatment and recovery. By triggering underlying vulnerabilities, they increase the likelihood of the condition manifesting earlier or more intensely. By worsening mood instability, alcohol can deepen depressive episodes.
Other drugs that are stimulants such as cocaine and amphetamines can trigger or intensify manic episodes. For people who use cannabis, it has been linked to increased mood instability and even psychosis risk.
How does alcohol consumption affect a person with this disorder?
Alcohol and drugs disrupt brain chemistry by altering neurotransmitters like dopamine and serotonin, which are already sensitive in individuals with bipolar disorder. This can lead to increased emotional volatility, poor impulse control, and heightened risk-taking behaviour.
When people with bipolar disorder who are on medication take alcohol or drugs, these substances reduce the effectiveness of mood-stabilising medications, increase side effects, and can lead to poor treatment adherence. This creates a vicious cycle driven by emotional distress, sleep difficulties, anxiety, or even treatment resistance.
What would happen if somebody who is genetically predisposed to bipolar disorder were addicted to alcohol?
If you are addicted to alcohol and carry a genetic predisposition for bipolar disorder, you are providing the right environment for it to manifest. Alcohol or drugs do not directly cause bipolar disorder, but they create conditions that allow it to emerge. As a result, it may appear earlier than it would in someone with the same genetic risk who does not use alcohol and whose bipolar would instead be triggered by other stressors.
Does alcohol regulate manic episodes for people with the disorder?
There is a misconception that alcohol can help regulate manic episodes. People with bipolar disorder sometimes experience overwhelming, unregulated emotions, especially if they are not compliant with medication. Since alcohol is a depressant, it may temporarily lower that euphoric state.
However, alcohol cannot be used to regulate mood. It disrupts neurotransmitters in the brain. You may feel regulated for a short time, but then you return to an unregulated state, leading you back to alcohol. This creates a vicious cycle and increases the risk of alcohol addiction.
How is bipolar disorder diagnosed?
Psychiatrists conduct comprehensive clinical assessments, evaluating symptoms, mood patterns, and personal and family history based on criteria in the *DSM-5*.
A psychiatrist will examine symptoms, including the severity and duration of manic (high energy/mood) and depressive (low mood) episodes, and identify the type of episodes.
Individuals are often asked to keep a record of their moods, sleep patterns, and daily habits. Tests may also be conducted to rule out substance abuse, medication side effects, or other mental health conditions such as ADHD. With consent, doctors may interview family members or close friends to understand behaviour patterns. You cannot diagnose yourself with the condition.
How common is this disorder in Kenya?
A 2020 report by the Taskforce on Mental Health from the Ministry of Health pointed out that mental illnesses such as depression and suicide, substance use disorder, bipolar disorder, schizophrenia, and other psychoses account for 13 per cent of the entire disease burden in Kenya.
How is bipolar disorder managed?
There is no cure for bipolar disorder; however, it can be managed, often for a lifetime. You will be required to take medication as directed by your doctor. We manage bipolar disorder; we do not treat it.
What are some red flags that a person’s drinking is beginning to fuel the disorder?
Loss of impulse control and hypersexuality: A sudden shift toward high-stakes, risky behaviours that the person would usually avoid when sober is a prominent red flag. These are not just drunken mistakes but consistent patterns of reckless endangerment, such as excessive speeding or dangerous driving without regard for safety.
Financial impulsivity: Pathological gambling or “betting it all” while under the influence.
Hyper-aggression: Becoming volatile, belligerent, or physically uncontrollable to a degree that far exceeds the situation.
Behavioural mimicry: Alcohol can act as a trigger for internal processes that look identical to a bipolar state. Red flags include extreme grandiosity, rapid speech, and a total inability to be reined in by friends or family.
Suicidal behaviour: Alcohol can strip away emotional defences, leading to sudden, acute suicidal ideation or self-harm attempts during a drinking session.
How can this condition affect a person's life?
If not well managed, the disorder can affect a person’s relationships. When an episode occurs, those around them may not understand where the behaviour is coming from.
It also undermines the work environment. A person may create drama at work, call their bosses names, or post questionable content on social media. Sometimes, individuals miss work because they cannot attend to clients while experiencing an episode.
The disorder also affects finances. Some people gamble away their entire salaries during manic episodes.
Does the combination of alcohol and bipolar disorder affect men and women differently?
While bipolar disorder does not discriminate by gender, the way it interacts with alcohol consumption and cultural expectations can create a more severe trajectory for men than for women.
In many cultures, higher rates of alcohol consumption among men mean that the fuel for bipolar symptoms is more readily available and socially encouraged. This leads to a higher frequency of severe episodes, as heavy drinking consistently triggers and exacerbates the highs and lows of the disorder.
Women often benefit from cultural norms that encourage sharing and emotional transparency. By sharing openly with one another, they create informal support systems that can act as a pressure valve for the environmental distress that often triggers bipolar episodes.
Conversely, men are frequently conditioned to bottle up their emotions. This internalising of stress creates a volatile internal environment. When a man is navigating the complexities of bipolar disorder, this cultural mandate for silence can prevent early intervention and healthy processing.
Call to action
Addressing the intersection of bipolar disorder and substance use requires more than awareness; it demands a shift in how we speak, act, and seek care.
Stop the casual labelling
The public must move away from self-diagnosis and the casual use of “bipolar” as an adjective for everyday mood swings. When clinical terms are used to describe ordinary weather patterns or minor indecisiveness, we diminish the severity of the lived experience of those actually managing the disorder.
Seek professional clarity, not internet answers
If you find yourself struggling with emotional volatility or suspect you are exhibiting symptoms, the first step must be a visit to a qualified health facility or professional organisation. The internet is a tool for information, not a substitute for a diagnosis. Early intervention is the most effective way to prevent the disorder from escalating into a crisis fuelled by alcohol or other triggers.
Commit to the continuum of care
A diagnosis is not a one-time event but the beginning of a management journey. One of the most dangerous hurdles in mental health care is the premature cessation of treatment. Patients must follow through with their medical protocols until a doctor advises a change in management. Quitting medication or skipping appointments without professional guidance can lead to severe relapses.
Bridge the gap between science and society
True stability is rarely achieved through medication alone. We must advocate for a holistic approach that combines medical management with robust psychosocial support. While clinical treatment addresses the biological imbalance, community support, counselling, and social understanding address the human element. For someone managing bipolar disorder, this double thread of support is what makes long-term health sustainable.
